The performance of two automatic servo-ventilation devices in the treatment of central sleep apnea

Abstract

Introduction: This study was conducted to evaluate the therapeutic performance of a new auto Servo Ventilation device (Philips Respironics autoSV Advanced) for the treatment of complex central sleep apnea (CompSA). The features of autoSV Advanced include an automatic expiratory pressure (EPAP) adjustment, an advanced algorithm for distinguishing open versus obstructed airway apnea, a modified auto backup rate which is proportional to subject's baseline breathing rate, and a variable inspiratory support. Our primary aim was to compare the performance of the advanced servo-ventilator (BiPAP autoSV Advanced) with conventional servo-ventilator (BiPAP autoSV) in treating central sleep apnea (CSA).

Study design: A prospective, multicenter, randomized, controlled trial.

Setting: Five sleep laboratories in the United States.

Participants: Thirty-seven participants were included.

Measurements and results: All subjects had full night polysomnography (PSG) followed by a second night continuous positive airway pressure (CPAP) titration. All had a central apnea index ≥ 5 per hour of sleep on CPAP. Subjects were randomly assigned to 2 full-night PSGs while treated with either the previously marketed autoSV, or the new autoSV Advanced device. The 2 randomized sleep studies were blindly scored centrally. Across the 4 nights (PSG, CPAP, autoSV, and autoSV Advanced), the mean ± 1 SD apnea hypopnea indices were 53 ± 23, 35 ± 20, 10 ± 10, and 6 ± 6, respectively; indices for CSA were 16 ± 19, 19 ± 18, 3 ± 4, and 0.6 ± 1. AutoSV Advanced was more effective than other modes in correcting sleep related breathing disorders.

Conclusions: BiPAP autoSV Advanced was more effective than conventional BiPAP autoSV in the treatment of sleep disordered breathing in patients with CSA.

Keywords: Bilevel positive pressure ventilation; auto EPAP; central sleep apnea; pressure support; servo-ventilation.

Figure 1

A 5-min epoch of a polysomnogram showing EPAP pressure automatically titrating in response to partially closed airway. LEOG, Left Eye; REOG, Right Eye; CHIN, CHIN EMG; THO, Thoracic Belt; CFLOW, Patient Flow; ABD, Abdominal Belt; PatPress, Patient Pressure; SetIPAP, IPAP pressure; SetEPAP, EPAP pressure; Micro, Snore Microphone; SpO₂, Oxygen Saturation.

Figure 2

Shows the individual apnea-hypopnea index comparing diagnostic PSG, CPAP titration study, BiPAP autoSV, and BiPAP autoSV Advanced. There is a significant reduction in the apnea-hypopnea index with either the previous generation of BiPAP autoSV or BiPAP autoSV Advanced (P < 0.001). However, there is also a significant further reduction in AHI with BiPAP autoSV compared to BiPAP autoSV Advanced (P = 0.0354).